<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-type" data-rule="required" class="form-control selectpicker" name="row[type]">
                {foreach name="typeList" item="vo"}
                    <option value="{$key}" {in name="key" value="$row.type"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_id" data-rule="required" data-source="order/index" class="form-control selectpage" name="row[order_id]" type="text" value="{$row.order_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_sn')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_sn" data-rule="required" class="form-control" name="row[order_sn]" type="text" value="{$row.order_sn|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Member_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-member_id" data-rule="required" data-source="member/index" class="form-control selectpage" name="row[member_id]" type="text" value="{$row.member_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Card_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-card_number" class="form-control" name="row[card_number]" type="text" value="{$row.card_number|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name1" class="form-control" name="row[name1]" type="text" value="{$row.name1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name2" class="form-control" name="row[name2]" type="text" value="{$row.name2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name3" class="form-control" name="row[name3]" type="text" value="{$row.name3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name4')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name4" class="form-control" name="row[name4]" type="text" value="{$row.name4|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name5')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name5" class="form-control" name="row[name5]" type="text" value="{$row.name5|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name6')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name6" class="form-control" name="row[name6]" type="text" value="{$row.name6|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name7')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name7" class="form-control" name="row[name7]" type="text" value="{$row.name7|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name8')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name8" class="form-control" name="row[name8]" type="text" value="{$row.name8|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name9')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name9" class="form-control" name="row[name9]" type="text" value="{$row.name9|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name10')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name10" class="form-control" name="row[name10]" type="text" value="{$row.name10|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name11')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name11" class="form-control" name="row[name11]" type="text" value="{$row.name11|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name12')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name12" class="form-control" name="row[name12]" type="text" value="{$row.name12|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark" class="form-control" name="row[remark]" type="text" value="{$row.remark|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-image" data-rule="required" class="form-control " rows="5" name="row[image]" cols="50">{$row.image|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
